Cor Vasa 2002, 43(7-8):325-330

The TIGER study. The efficacy and tolerability of trimetazidine in geriatric patients exertion angina pectoris

František Kölbel^1,*, Viliam Bada²

¹ Interní klinika, Fakultní nemocnice Motol a 2. lékařská fakulta Univerzity Karlovy, Praha, Česká republika

² III. Interná klinika, Fakultná nemocnica akademika L. Dérera a Lekárska fakulta Univerzity Komenského, Bratislava, Slovenská republika

Aim of study:
To evaluate the efficacy and tolerability of the myocardial energy metabolism modulator trimetazidine (TMZ), a 3-ketoacyl-coenzyme A thiolase (3-KAT) inhibitor in elderly patients with stable exertion angina pectoris.

Method:
A total of 120 patients aged 65-86 years (mean 70 ± 4 years) with chronic stable exertion angina pectoris were included into the study. Ninety of these individuals (75%) had a history of myocardial infarction. Exercise testing was performed twice within a week prior to inclusion (T-1, T0); next, oral TMZ at a dose of 20 mg three times a day was added to therapy stable for at least 4 weeks before study initiation. This therapy was continued until the end of the study. The final exercise testing was performed at 12 weeks of the above therapy (T12). Therapeutic efficacy was tested by exercise time during exercise testing, total work, interval to the development of 1-mm ST segment depressions, number of anginal attacks, and average consumption of short-acting nitroglycerin.

Results:
Exercise time between T0 and T12 prolonged by 52 ± 92 s (p < 0.001), total work increased by 5 416 ± 11 276 Ws (p < 0.001), time to the development of 1-mm ST segment depression prolonged from 358 ± 160 s to 399 ± 182 s (p < 0.001). The average number of episodes of chest pain per week decreased from 5.5 ± 9.7 to 2.2 ± 5.5 and the average weekly consumption of short-acting nitrate declined from 4.4 ± 7.2 to 1.4 ± 3.3; p < 0.001 for all changes. The value of the rate-pressure product (heart rate × systolic blood pressure) did not change significantly throughout the test. Efficacy was evaluated, by physicians, as excellent or good in 87% of patients. Quality of life during therapy was rated as excellent or good by 89% of patients. There was one death during the study, two patients developed acute myocardial infarction. Adverse reactions were observed in seven patients; however, they were related to TMZ therapy in only two (epigastric discomfort and dyspepsia). In both cases, the reactions were mild and of short duration.

Conclusion:
In very old patients with stable exertion angina, in whom standard (most commonly drug) therapy failed to completely eliminate chest pain attacks, addition of trimetazidine to current therapy improved the results of exercise testing and decreased the frequency of chest pain attacks; the pain disappeared altogether in 32% of patients. The study showed that TMZ as an agent with a primary effect on metabolism and devoid of an effect on hemodynamic parameters, possesses very good effects in and is well tolerated by elderly patients.

Keywords: Exertion angina pectoris; Geriatric patient; Trimetazidine; Exercise testing; Quality of life

Published: July 1, 2002  Show citation